Provider Demographics
NPI:1003905639
Name:BANKOWSKI, JOHN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BANKOWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 9TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5833
Mailing Address - Country:US
Mailing Address - Phone:202-285-6214
Mailing Address - Fax:
Practice Address - Street 1:1100 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4101
Practice Address - Country:US
Practice Address - Phone:202-223-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP717152W00000X
NE1194152W00000X
NY006055152W00000X
ALR138152W00000X
MDTA1200152W00000X
CO2359152W00000X
PAOE008140P152W00000X
MN2793152W00000X
MI4901004174152W00000X
MO2005001747152W00000X
SC1142152W00000X
IDODP1047152W00000X
IN18003267A152W00000X
WI2967035152W00000X
IA02213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD808MJ019Medicare ID - Type Unspecified
DCG01452F02Medicare ID - Type Unspecified
DCU99053Medicare UPIN
MDU99053Medicare UPIN